How To Use HCPCS Code G8848

HCPCS code G8848 describes mild obstructive sleep apnea, specifically referring to an apnea hypopnea index (AHI) or respiratory disturbance index (RDI) of less than 15. This code is used to identify and classify cases of mild obstructive sleep apnea, which is a common sleep disorder characterized by partial or complete blockage of the upper airway during sleep.

1. What is HCPCS G8848?

HCPCS code G8848 is a specific code used in medical coding to identify and classify cases of mild obstructive sleep apnea. It is important for medical coders to accurately assign this code to ensure proper documentation and billing for patients with this condition.

2. Official Description

The official description of HCPCS code G8848 is “Mild obstructive sleep apnea (apnea hypopnea index (AHI) or respiratory disturbance index (RDI) of less than 15).” This description clearly indicates that this code is specifically used for cases of mild obstructive sleep apnea with a lower severity level.

3. Procedure

1. Patients with mild obstructive sleep apnea typically undergo a sleep study or polysomnography to diagnose the condition. During the sleep study, various parameters are monitored, including airflow, oxygen levels, brain activity, and muscle movements.
2. The apnea hypopnea index (AHI) or respiratory disturbance index (RDI) is calculated based on the number of apneas (complete blockage of airflow) and hypopneas (partial blockage of airflow) per hour of sleep.
3. If the AHI or RDI is less than 15, the patient is classified as having mild obstructive sleep apnea, and HCPCS code G8848 is assigned for documentation and billing purposes.

4. When to use HCPCS code G8848

HCPCS code G8848 should be used when documenting and billing for patients with mild obstructive sleep apnea. It is important to note that this code is specifically applicable for cases with an AHI or RDI of less than 15. If the AHI or RDI is equal to or greater than 15, a different code should be used to reflect the appropriate severity level.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G8848, healthcare providers should ensure proper documentation of the patient’s diagnosis of mild obstructive sleep apnea with an AHI or RDI of less than 15. This documentation should be supported by the results of a sleep study or polysomnography, which should include the calculated AHI or RDI value.

When billing for services related to mild obstructive sleep apnea, providers should follow the specific billing guidelines set forth by Medicare or other insurance carriers. It is important to accurately assign the appropriate HCPCS code and include all necessary supporting documentation to ensure proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G8848 was added to the Healthcare Common Procedure Coding System on January 1, 2012. It has an effective date of January 1, 2017, indicating that it was terminated on December 31, 2016. This means that this specific code is no longer in use for documentation and billing purposes.

7. Medicare and Insurance Coverage

HCPCS code G8848 falls under the coverage code C, which indicates that coverage is determined by the carrier’s judgment. This means that Medicare or other insurance carriers may have specific guidelines or criteria for coverage of services related to mild obstructive sleep apnea.

The pricing indicator code for HCPCS code G8848 is 00, which means that the service is not separately priced by Part B. This indicates that the service may be bundled or not covered by Medicare or other insurers.

8. Examples

Here are five examples of when HCPCS code G8848 should be billed:

1. A patient undergoes a sleep study, and the results indicate an AHI of 10, classifying the patient as having mild obstructive sleep apnea.
2. A physician diagnoses a patient with mild obstructive sleep apnea based on symptoms and medical history, and the patient’s AHI is documented as 12.
3. A patient with a history of snoring and daytime sleepiness undergoes a sleep study, and the results show an RDI of 14, confirming a diagnosis of mild obstructive sleep apnea.
4. A sleep specialist evaluates a patient with complaints of restless sleep and fatigue, and the patient’s AHI is determined to be 8, indicating mild obstructive sleep apnea.
5. A patient presents with symptoms of mild obstructive sleep apnea, and a sleep study reveals an RDI of 11, supporting the diagnosis.